New GAO Report on Federal Parity Law

On Nov. 30, 2011, the Government Accountability Office (GAO) released the first of two reports mandated by Congress on the Mental Health Parity and Addiction Equity Act (MHPAEA). The next report is due by Oct. 2013. This report was mandated in the MHPAEA in order to provide a complete analysis of trends in coverage or exclusions as originally requested by Congress. Initial review of the report indicates that it falls short on documenting the rise in treatment limitations or non-quantitative treatment limits (NQTLs) that have been growing as group health plans have moved into compliance with the law.

Among the highlights in the report:

Only two percent of employers reported dropping mental health and/or substance use disorder coverage in response to the law.

Forty-one percent of plans reported excluding a specific mental health or substance abuse disorder treatment in the current plan year, compared to 33 percent that reported doing so in 2008. It should be noted that the report does not detail which treatments are most commonly excluded.

The report only briefly covers the issue of parity in “scope of services,” without providing recommendations or detailed analysis. It states that the 2009 Interim Final Regulation (IFR) does not specifically “address the scope of services offered within each classification benefit and agency officials recognize that achieving parity in coverage is complicated by the fact that not all treatment or treatment settings for MH/SU correspond well to those for medical/surgical.” The report goes on to note that “experts reported that some employers are unclear what types of services for MH/SU they must offer within the IFR’s six classification to be in compliance with MHPAEA and its implementing regulations. These employers may modify their MH/SU benefits in response to the final regulations.”

The report also fails to address how plans are, or are no,t operationalizing non-quantitative treatment limits (NQTLs) and its impact on coverage.

Finally, there are only limited references to the obligation of Medicaid managed care and SCHIP plans to comply with federal parity.

Additional background information on implementation of the federal parity law and guidance to help ensure that your group health plan is in compliance with the MHPAEA (including materials on how to file a complaint) is available at the Parity Implementation Coalition website at:
www.mentalhealthparitywatch.org/Pages/mentalhealthparity.aspx